children’s health

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A new study out of Boston Children’s Hospital paints a bleak picture of the social lives of many kids who identify as lesbian, gay or bisexual: As early as fifth grade, researchers report, these sexual minority youth are far more likely than their peers to be bullied.

This ongoing victimization (defined in the study as at least once a week over the course of a year) can have short-term consequences, of course, but can also lead to problems down the road. Those long-term troubles include, for instance, “anxiety, low self-esteem, depression, suicidal ideation, post-traumatic stress and negative school performance,” according to the study’s lead author, Mark Schuster, MD, PhD, chief of general pediatrics at the children’s hospital and professor of pediatrics at Harvard Medical School.

For the study, published in the New England Journal of Medicine, researchers interviewed over 4,000 fifth graders and followed up with the kids again in seventh and 10th grade. In an accompanying video Schuster offers this takeaway:

What we found is that the kids who were sexual minorities were more likely to report bullying in all three grades, in 5th grade, 7th grade and 10th grade, and this was true for the boys and the girls. What was particularly striking, in 5th grade, before most of these kids would even be aware of their own sexual orientation, their own identity, or the orientation of their peers, they’re already being bullied more…

That really stood out, and it suggests that these kids, by the time they’re in 10th grade they’ve been bullied and bullied and bullied over many years.

In this context, bullying is defined as “the intentional and repeated perpetration of aggression over time by a more powerful person against a less powerful person.” In the study, researchers suggest that screening for “bullying experiences” should become more commonplace:

“Our findings underscore the importance of clinicians routinely screening youth for bullying experiences, remaining vigilant about indicators of possible bullying (e.g., unexplained trauma and school avoidance), and creating a safe environment in which youth feel comfortable discussing their sexuality. Further research could determine the effectiveness of incorporating the experiences of sexual minorities into general school-based anti-bullying programs.”

So how can parents help? In an interview Schuster offers this:

There are several things parents should be doing: creating an environment in the household where their kids feel comfortable being open with them, and an environment where the kids feel unconditional love. One of the places kids learn to bully is from watching adults around them; kids learn from their parents. So if a neighbor’s name comes up and he’s known to be gay and dad does the limp wrist thing, or mocks the neighbor, and the kid observes that, the kid learns it’s OK to mock based on who they are. It also sends a message that if there’s a gay child in the house who is not out, the message is that the kind of person dad is scorning or mocking is not just the neighbor but also the child, and that’s a terrible experience for a child, to feel that their own parent would reject them. Continue reading →

April 30, 2015 | 10:49 AM | Dr. Elliott B. Martin, Jr.

News this week that the Prouty Garden at Boston Children’s Hospital can be bulldozed continues to draw impassioned pleas to reconsider the garden’s fate. Here, Dr. Elliott B. Martin, Jr., a psychiatrist at Newton-Wellesley Hospital and Assistant Clinical Professor of Psychiatry Tufts University School of Medicine, adds his thoughts. (This is the second powerful letter we’ve received from defenders of the garden. We also welcome letters from the other side.)

I am writing in hopes of continuing the narrative around the fate of the Prouty Garden at Boston Children’s Hospital. I have been involved now for several months in the effort to save the therapeutic space, and the letter yesterday from Ms. Ellen Gilliam has inspired me to build upon her story, in hopes that others will add their own chapters.

I, too, have worked at Boston Children’s Hospital, as a physician, specifically as a psychiatrist. Until recently, the best kept secret at Children’s Hospital had been that there is in fact an inpatient psychiatric unit there. At any given time the hospital cares for some of the most grievously traumatized children you can imagine. These are kids, ranging from seven to seventeen years old, who have suffered ungodly physical and sexual abuse, at times since infancy. These are kids who have suffered from neglect, at times to near death. These are kids with profound depression, who have tried to commit suicide, very often many times over.

Therapeutic options in such cases are extremely limited, often amounting to time, containment, support, and most importantly, love. Many, if not most, of the physically ill children at the hospital at the very least know the love of their families. For the psychically wounded there is precious little love. As we would often observe on the inpatient unit, very few people sent get well cards to the psychically ill. The clowns never came there. The celebrities, on their visits to sick children, were carefully shuttled past the double-locked doors designed to be disinviting.

In this environment two therapeutic modalities stood out as having had immediately tangible, positive effects on these children. The first was the weekly visit from the therapy dog, and the second were the daily supervised excursions to the Prouty Garden. For kids otherwise confined day and night to a tiny, cordoned off piece of hospital property these fifteen to thirty minute trips were their only connection to the greater world, the ‘world outside’, as one horrifically abused seven year old boy once described it to me. To see these kids playing in the garden one might even mistake them for “normal’ kids. To see them interact with children in wheelchairs, with children wheeling IV poles, with children sentenced to die and whose parents had nowhere else to cry, one might think they were even more than normal, that they were, at least for a few minutes, special. Continue reading →

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev. Tsarnaev was found guilty and now faces the death penalty. (Jane Flavell Collins/AP)

Killing is the ultimate bad, right? That’s what we teach our children. So how do we talk to them about the very real possibility, splattered across our screens and newspapers, that we may put a young man to death for his crimes?

“I think he should die,” said my 9-year-old child when I raised the question leading the news this week: whether Boston Marathon bomber Dzhokhar Tsarnaev should be sentenced to death or life in prison. “If he killed [four] people and injured hundreds and ran from it he should have a very serious consequence.”

“Life in prison is worse,” said my older daughter.

The conversation then turned to what kinds of people commit crimes and why, and by the end, my young daughter was not so sure about the death penalty. Needless to say, it’s complicated.

Earlier this month, Tsarnaev, 21, was convicted on all 30 counts against him and was found responsible for the deaths of three spectators at the 2013 marathon as well as the fatal shooting of an MIT police officer.

Today, defense lawyers are making the case for life in prison for Tsarnaev, rather than the death penalty. The public, is seems, is also leaning in that direction: A recent WBUR poll found that only 31 percent of Boston area residents say they support the death penalty for Tsarnaev.

So how do we talk to our kids about all of this?

Shamaila Khan, Ph.D., is director of behavioral health at the Massachusetts Resiliency Center, a program of Boston Medical Center, and has been attending the Tsarnaev trial regularly, providing support for survivors at the courthouse. She was a responder on the day of the marathon in 2013 working with families and individuals brought to BMC. She has also worked closely with families affected by the bombing and its aftermath, including people in Watertown who were impacted by the hunt for the Tsarnaev brothers days after the bombings.

I spoke with Khan about how to help parents talk about these tough issues — life and death, justice and punishment and revenge — with children. Here, edited, is some of our conversation:

RZ: So, as a parent, how do you begin to talk to children about these complex issues?

SK: This is a very controversial topic. It’s hard enough for adults to talk about it, let alone children. Children respond differently based on their developmental level — depending on what age they are and where they are developmentally. But there are three basic things to consider: listening, protecting and connecting.

RZ: OK, can you give some more detail please?

So, first, listen. Ask the children if they’ve heard about this, and what they know. With social media, there’s so much information available and often children know more than parents think. If they have heard about this, listen to what they have to say. Often, our tendency as adults is to start explaining — first let the children tell you what they know. Once you know that, you can figure out how to answer their questions, and find out what they are curious about. If they are expressing opinions at one end of the spectrum [like my daughter], offer them another point of view, maybe something like, ‘Who knows why this person did this?’ and give them more information. Help them to think about it in a more complex way, highlighting the variation on the spectrum. But remember, sometimes not telling the whole truth is important.

Like if a child, say up to 12 years old, asks how exactly does the death penalty get carried out, you might want to explain it in a way that demonstrated how it’s done with the individual experiencing the least amount of pain. You can be kind of vague and abstract. I’ve given examples of a pet that needs to be put to sleep: It happens in a way that doesn’t hurt them. So, a little abstract and not giving all the graphic detail unless asked. You can explain the death penalty by saying, for example, there’s a process in place, and different ways that it can be done. They try to figure out the least painful method, maybe medication or an injection. They used to do worse things but they don’t do that any more. Just keep it simple and abstract.

So you also said “protecting” is important. How does that work in this context?

Children, no matter what you’re talking about, they think about their own self and safety: Where is this person? Can this person get out of prison and hurt me? Is he in the same town where we live? Is he chained up? What kind of person does this and can there be anyone else around to do this to me? So the child’s own sense of safety is triggered. As parents you want to make sure the kids are feeling protected and safe. So just reassuring them is important.

And “connection” — where does that come in?

Connection is about making sure their support system is in place. You make it clear that you are there as a parent or parents, and other people are around, teachers, family members and others. You make sure there are other people and systems in place and say, ‘If you ever want to talk, there are people around to talk to.’ Often children stay curious, and if talking is not what they want, offer them activities that give them other ways to address their feelings: write a letter — What would you say to this person? — write in a journal, create a drawing… Continue reading →

February 9, 2015 | 4:22 PM | Steve Schlozman

Even writing the word “snow” now makes me cranky at this point. I never thought I would actually long for the morning commute.

But, I did in fact sign up to be available for my kids, and this is actually a bigger problem right now than any of us expected. The weather in Boston has of course been unprecedented, and while it would be foolish and infantile to act like it is anything other than a royal pain in the backside, we’d also be committing a big fat empathic failure if we didn’t acknowledge just how stir crazy we’re going.

I have developed new sympathy for my daughter’s hamster; she see’s the same cage, the same scene, the same everything, day in and day out.

But, alas, my kid’s hamster cannot work scissors, or a remote control for the television, or engage in any sort of higher order thinking, such as hitting her big sister in the back of the head with a pillow.

In the interest of the city not losing it’s collective mind, and in the interest of genuine public health, may we offer some suggestions. You’ve gotta mix it up right now. If there was a Super Bowl of day-killing, we’d be having a major parade by now. Sundown is still a long ways off. Here are ten tips to pass the day with minimal damage

Screen Time
I wouldn’t fret too much about TV or computer time. Limit the screen time in a way that makes sense to you, and limit what they watch. My family had to put the kabash on Dance Moms, for example It just got a bit too toxic. But use entertainment, in a family way if possible, and set the boundaries around what is watched as well as for how long. For example — say something like: at noon, you can watch/play (fill in the blank with appropriate program) for one hour. Then you can watch/play (fill in the blank with appropriate show) at 4 pm again.

Jigsaw puzzles

I know. “Boring,” your kids will sing. But puzzles have a unique appeal around a living room table. That burst of satisfaction when two pieces fit together has got to be neurobiologically driven. It just feels so good. Thirty minutes or more with a good jigsaw puzzle, even one you’ve done before, is both calming and rewarding.

Food

Speaking of calming and rewarding, don’t forget to feed ‘em, and don’t indulge in excess either. Remember that for most kids, there is structure during the day in the form of lunchtime and recess and activity time. I’m a big believer in free and unstructured time, but in recent days we’ve been closing in on Lord of the Flies territory. Feed ‘em at the table and then let them move onto other things. The meal should take around 20 minutes. You might get more time out of it if you bake something. (That’s the length of the average meal at school)

It’s going to be a long, long day. If you’re like us, you’ve already cooked some kind of elaborate breakfast, chosen the morning movie lineup, and set up the “Let’s Dance” Wii. And it’s not even 8 a.m.

When you’re ready to venture outside and “play,” remember it’s freezing, with ferocious winds. No doubt you’re familiar with this kind of extreme weather, but there are a few health tips worth repeating. Here’s the Boston Public Health Commission with a cute video reminder:

If you’ve never considered your dog or cat part of your social network, maybe it’s time to start.

A new study from the University of Missouri-Columbia finds that pets of any kind in the home may help autistic children develop crucial social skills.

Gretchen Carlisle, research fellow at the Research Center for Human-Animal Interaction in the M-U College of Veterinary Medicine, found that pets serve as a “social lubricant,” making kids more likely to engage in behaviors such as introducing themselves, responding to other people’s questions or asking for more information.

While researchers have already found that dogs provide great assistance to children with autism, Carlisle explains that her study looks at the possible benefit of all types of pets. These pets also help the greater public interact with autistic kids in social settings. “When children with disabilities take their service dogs out in public,” adds Carlisle, “other kids stop and engage. Kids with autism don’t always readily engage with others, but if there’s a pet in the home that the child is bonded with and a visitor starts asking about the pet, the child may be more likely to respond.” Continue reading →

July 15, 2014 | 10:41 AM | Veronica Thomas

You wake up to your 8-year-old son crying in the middle of the night. He’s had a sore throat for a few days, which the pediatrician is treating with liquid Tylenol. As you grab the bottle and kitchen spoon from the medicine cabinet, you wrack your brain trying to remember the doctor’s instructions. Was it two teaspoons or two tablespoons? But wait, the pharmacist had said to measure it in milliliters.

Parents who used teaspoons or tablespoons were twice as likely to make a mistake.

A new study in the journal Pediatrics found that around 39 percent of parents incorrectly measured the dose they intended and about 41 percent made an error in measuring what their doctor had prescribed. The researchers found that parents who used teaspoon or tablespoon units for medications were twice as likely to make a mistake in measuring the dose compared to parents who only measured medications in milliliters.

This increased error may partly be due to the fact that parents measuring in teaspoons or tablespoons are more likely to use a kitchen spoon to measure the medication, rather than a standardized instrument like an oral syringe or cup. However, even parents using standardized instruments were more likely to make a dosing mistake if they used teaspoon or tablespoon units. The link between tablespoon or teaspoon use and measurement error was even stronger among parents with low health literacy or limited English proficiency.

To minimize this confusion and reduce medication errors among parents, the study investigators suggest adopting a milliliter-only unit of measurement. But while a standardized unit of measure seems like the logical fix, it probably won’t be a quick one, according to Dr. Shonna Yin, the lead investigator of the study.

She sees growing support for a move towards a standard milliliter system from groups like the American Academy of Pediatrics, the American Academy of Family Physicians and the American Association of Poison Control Centers, but says concerns remain that this transition would cause greater confusion, since parents are familiar with teaspoon and tablespoon terms.

I asked Dr. Yin, from the New York University School of Medicine and Bellevue Hospital Center, to provide additional insight on the study’s implications, including what parents can do to reduce dosing errors. Our conversation, edited:Continue reading →

March 28, 2014 | 11:40 AM | Marina Vyrros

For the past four years, I’ve been involved with a local nonprofit, the North Cambridge Family Opera, which stages original productions featuring cast members age 7 to grandma, and with a range of abilities. In 2011, I wrote about how performing in the group’s opera helped children with autism. This year, I was struck by the story of how music helps heal the past trauma of one young cast member, 8-year-old Aster, adopted from Ethiopia after her birth parents died. I asked Aster’s mother to write a bit about their experience. Here’s her post:

By Marina Vyrros
Guest contributor

In the mid 1990s, I worked as a refugee aide in the Guatemalan rainforest.

Many people in that community — having fled horrific atrocities, like their villages being razed or worse — were suffering from post-traumatic stress.

Atrocities notwithstanding, a contingent of ranchero musicians somehow managed to lug homemade, oversized guitars to the camps and play music each night, often in the 100-degree heat.

While the NGO’s provided a valuable service — helping the people rebuild their external structures — the service that the ranchers provided, though perhaps less tangible, was invaluable. Their nightly gatherings, singing songs about their plight, helped the community to rebuild and heal internally.

Four years ago, when I adopted an almost 4-year old child from Ethiopia (who continues to recover from the trauma of having lost both birth parents during her formative, early childhood years) the lesson of the power of music was not lost on me.

Claudia M. Gold, a pediatrician, blogger and author of “Keeping Your Child in Mind: Overcoming Defiance, Tantrums, and Other Everyday Behavior Problems by Seeing the World Through Your Child’s Eyes,” explains what may be going on in my daughter’s brain:

“Severe meltdowns are common in children who have experienced early trauma, at the time when the higher cortical centers of the brain were not yet fully developed. Stress of a seemingly minor nature can lead the rational brain to in a sense go ‘off-line.’ The child will have access only to the lower brain centers that function more instinctively.”

Especially during her first few years in Cambridge, Aster’s meltdowns were epic, but music and dance have consistently provided the most important vehicle to help her regulate her emotions.

Before, she might bang on the walls, now, to relieve her frustration, she pounds on a djembe, an African drum, in an afterschool program; instead of crying over seemingly inconsequential things, now, to release her emotions she invents and belts out Whitney Houston-y type songs, tears streaming down her face. To release her energy — which is abundant — she dances around. Everywhere. It all helps.

Recently, over the past five months, Aster’s been singing, dancing and even acting with the North Cambridge Family Opera based in Cambridge. In this year’s production, “Rain Dance,” she and the other animals living on the South African savannah elect a Machiavellian lion in a desperate attempt to end the local drought. Trouble ensues.

All kinds of research suggests that music can minimize the symptoms of post traumatic stress and other types of trauma. A 2011 study found that guitar-playing can help veterans with PTSD drown out the traumatic memories of bombs blasting; and in 2008 researchers found some reduction of post-traumatic stress symptoms following drumming, in particular “an increased sense of openness, togetherness, belonging, sharing, closeness, connectedness and intimacy, as well as achieving a non-intimidating access to traumatic memories, facilitating an outlet for rage and regaining a sense of self-control.”

My 11-year-old daughter recently asked if she could take a hot yoga class with me. My first reaction was negative: it’s too hot, it’s not “fun” and it’s one of the few things I do that’s truly mine — 90 minutes in which I don’t have to worry about anyone else’s needs.

Of course, I said yes. And I’m glad I did. She made it through class, and was totally into it (though she wished there’d been more “tricks” and less pose-holding).

“That was great, Mom,” she said afterwards. “When’s the next class?” And whether she becomes a yoga fan or not, I consider those 90 minutes to be a small gift: another way for me to show her how strong and able a body can be, and how good it feels. It doesn’t much matter if it’s yoga or running or swimming or playing ultimate frisbee — our kids are clearly taking their physical activity cues from us.

A new study out of the U.K. confirms this: researchers report that physical activity levels in mothers and their pre-school kids are directly associated. The study, published in the journal Pediatrics, suggests that interventions to promote more physical activity among mothers (who, understandably, are often exhausted, harried and not great at fitting exercise into busy, kid-filled days) might also benefit their young children.

Here’s some of NPR’s report on the study of 554 mothers and their kids:

It’s not entirely clear whether it’s the mother’s activity that influences her child’s, or if mothers are more active because they’re busy keeping up with a playful child, says Esther van Sluijs, a behavioral epidemiologist at the University of Cambridge and the study’s lead author.

But busy mothers don’t have to drop all other priorities to play with their children all day. Van Sluijs says just small changes – walking to the park instead of driving or playing a good game of tag instead of a board game – can make a difference. Continue reading →

I grew up in the era of Marlo Thomas’ Free To Be You And Me, with gender-liberated lyrics like this: “Some mommies are ranchers or poetry makers, or doctors or teachers or cleaners or bakers, some mommies drive taxis or sing on TV, yeah, mommies can be almost anything they want to be.”

Indeed, Barbie dolls — with their overly sexualized, crazy-making-body-image implications — had no place in our little Brooklyn apartment.

Apparently, that was a smart move.

A small, but novel new study exploring gender roles and how kids imagine their future careers found something disturbing: little girls who were asked about 10 different jobs told researchers that boys could take on “significantly more occupations” than they could themselves. What’s more, according to the study, girls who played with Barbie dolls before being interviewed indicated fewer career options compared to boys, while girls who played with the far less sexy Mrs. Potato Head reported a smaller difference between future job options as compared to boys. The jobs mentioned to the kids were: teacher, librarian, day care worker, flight attendant, nurse, construction worker, firefighter, pilot, doctor, and police officer

allieosmar/flickr

The study (which I’m now calling “Mrs. Potato Head Rules” but is actually titled “Boys Can Be Anything”: Effect of Barbie Play on Girls’ Career Cognitions,”) involved 37 girls, ages 4-7. The research, led by Aurora M. Sherman, an associate professor in the School of Psychological Science Oregon State University with Sherman and Eileen L. Zurbriggen of the University of California, Santa Cruz, was published in the journal Sex Roles.

I asked Sherman via email how the project originated. She said that while there have been studies on what girls thought about fashion dolls like Barbie, there’d been “no actual experiments that could test whether playing with one kind of doll or another kind caused a difference in kids’ thinking.”

Sherman continued:

“I thought it would be interesting to test ideas girls have about careers as the outcome because there is a lot of emphasis on the 130+ careers Barbie has been dressed for, so it was logical to ask whether a Barbie costumed as a career professional (Dr. Barbie) would give girls a “boost” in their ideas about careers. However, that boost did not appear in my study…The lack of difference between Dr. Barbie and Fashion Barbie surprised me the most; it seems from our data that just a professional title and costume isn’t enough to expand the career horizons of girls when they play with Barbie.”

And while Sherman says she was interested in Barbie dolls as a child, “my parents didn’t allow them in my house. I didn’t have very many dolls of any kind as a kid, actually — my parents were more into providing games and books.” Continue reading →

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

Two Boston public school moms argue that a fraction of the money that Boston would have spent for the Olympics should go toward ensuring that all the city’s schoolchildren have the recess and gym time their bodies and minds need.